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Neurology > Head Trauma > Flashcards

Head Trauma Flashcards

1
Q

who are at high risk of head injuries

A 
young men and elderly 
previous head injuries 
residents of inner cities
alcohol and drug abuse 
low income
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2
Q

what do over half of head injuries involve

A

alcohol

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3
Q

when do most deaths occur after head injury

A

within first hour
then peak at 7 hours- secondary effects
3rd peak later due to medical complications- high risk of pneumonia, DVT, PE

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4
Q

what are the components of the glasgow coma scale

A

eye opening (4-1)

  • spontaneously
  • to speech
  • to pain
  • none

verbal (5-1)

  • orientated
  • confused
  • inappropriate
  • incomprehensible
  • no verbal

motor (6-1)

  • obeying
  • moves to localised pain
  • flexion withdrawal from pain
  • abnormal flexing (decorticate)
  • abnormal extension (decerebrate)
  • no motor response
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5
Q

which part of glasgow coma scale carries most significance

A

motor

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6
Q

what are the best and worst GCS scores

A

best 15

worst 3

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7
Q

when is a patient comatosed on GCS

A

8 or less

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8
Q

what are the parameters for head injury severity on GCS score

A

14/15, brief LOC= mild
9-13 = moderate
3-8= severe

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9
Q

patients with what risk factors should have a CT scan done within 1 hour of being identified

A 
GCS< 13 on initial assessment 
GCS< 15 2 hours after injury 
suspected open/ depressed skull fracture 
any sign of basal skull fracture
post traumatic seizure 
focal neurological deficit 
more than one episode of vomiting 
suspicion of NAI
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10
Q

who should get a CT if they experienced some LOC or amnesia since the injury

A

> 65
coagulopathy (medically induced or thrombophilia)
dangerous mechanism of injury

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11
Q

what does lacunar eyes mean

A

basilar skull fracture

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12
Q

what is battles sign

A

bruising over the mastoid - basilar skull fracture

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13
Q

what does any blood in CSF suggest

A

basilar skull #

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14
Q

what is DAI (found in CT in diffuse head injury)

A

diffuse axonal injury

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15
Q

what are the possible CT findings in a focal head injury

A

traumatic haemorrhage- extradural, subdural, intracerebral

contusion

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16
Q

what are the features of an extradural haematoma

A

blood cant cross suture lines - fills space
lens shape/ biconvex shape
more common in younger patients

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17
Q

what is the usual presentation of an extradural haematoma

A 
injury with LOC
has lucid interval in recovery 
rapid progression of neurological symptoms 
-deteriorating GCS
-possible hemiparesis/ wekaness
-unilateral fixed and dilated pupil 
-apnoea and death
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18
Q

what are the features of an acute subdural haematoma

A

more common in elderly
brain atrophy
bridging veins disrupted
will be hyPERdense

19
Q

what will a chronic subdural haematoma look like on imaging

A

hyPOdense

20
Q

what is an intracerebral haemoatoma

A

blood clot within the brain

21
Q

what is coup and contra-coup

A

coup- brain hits side of head that is impacted

contra coup- brian hits opposite side

22
Q

what causes a diffuse axonal injury

A

large shearing forces

23
Q

what is the neurosurgical role in head injury

A

prevent secondary insults

  • hypoxia
  • hypotension
  • mass lesions
  • controlling ICP and CPP (cerebral perfusion pressure)
24
Q

what formula calculated cerebral perfusion pressure

A

MAP - ICP

25
Q

what maintains good cerebral perfusion pressure

A

maintained MAP (up) and ICP (down) at right levels

26
Q

what are the basal cisterns

A

compartments within the subarachnoid space where the pia mater and arachnoid membrane are not in close approximation and cerebrospinal fluid (CSF) forms pools or cisterns

mass have vessels/ nerves running through them

27
Q

what does closure of the basal cisterns do

A

increases ICP

28
Q

how is ICP monitored

A

wire inserted into head

29
Q

what is the medical management for raised ICP

A

sedation- propofol, benzodiazepines, barbiturates
maximise venous drainage of brain - head tilt of bed (30 degrees), cervical collars, ET tube ties
co2 control
osmotic diuretics - mannitol, hypertonic saline
CSF release- external ventricular drain

30
Q

how does CO2 affect ICP

A

if CO2 is too high cerebral blood flow increases- increasing ICP

31
Q

what happens if arterial CO2 drops too low

A

reduce blood flow to brain by too much

32
Q

what is a decompressive craniectomy and when is it done

A

after all medical management of raised ICP is exhausted
take off part of cranium
saves lives but doesnt improve outcomes

33
Q

why do BP changes have such a big impact in head injury

A

as lose autoregulation, will directly impact cerebral blood flow

34
Q

why is nutrition important in head injury

A

need to feed patients NG early on

if not fed in 5-7 days after injury increase likelihood of death and mortality rate

35
Q

why do axons swell up in DAI

A

as the injury (stretched, sheared, twisted or compressed) allows more ions and water into the axon

36
Q

where do DAIs happen

A

where density difference is the greatest (grey/white interface)

37
Q

what happens after DAI

A

excitotoxicity and apoptosis
inflammatory mediator (cytokines, interleukins) response
neuronal death

38
Q

what is excitotoxicity

A

excitatory amino acids (gutamate) activates NMDA receptors
calcium mediated activation of proteases and lipases
cell death

39
Q

do steroids help in head injuries

A

no- causes toxic swellings

40
Q

what symptoms and signs suggest brainstem death

A 
no pupil response 
no corneal reflex
no gag reflex 
no vestibulo-ocular reflex (project cold water into one ear and look at eye movement)
no motor response 
no respiration
41
Q

what is the apnoea test

A

to look for brainstem death

Pre-oxygenate to look for a change in Co2 levels. Disconnect the ventilator and check pCO2 which must rise to 6 pKa

42
Q

what are the possible long term complications of a head injury

A 
Seizures
Depression
Alcohol and drug dependence
Personality change
Mood swings
Aggression
Recurrent behaviour – further head injuries
Failure of relationships
Loss of job
suicide
43
Q

what is ATLS

A

advanced trauma life support

  • airway with C spine control
  • breathing
  • circulation

Neurology (35 decks)

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